Diagnostic Accuracy of the Amsler Grid Test for Detecting Neovascular Age-Related Macular Degeneration

Abstract

ImportancePatients with nonneovascular age-related macular degeneration (AMD) are encouraged to use the Amsler grid test for self-assessment to facilitate early diagnosis. The test is widely recommended, suggesting a belief that it signals worsening AMD, warranting its use in home monitoring.ObjectiveTo systematically review studies of the diagnostic test accuracy of the Amsler grid in the diagnosis of neovascular AMD and to perform diagnostic test accuracy meta-analyses.Data SourcesA systematic literature search was conducted in 12 databases for relevant titles from database inception until May 7, 2022.Study SelectionStudies included those with groups defined as having (1) neovascular AMD and (2) either healthy eyes or eyes with nonneovascular AMD. The index test was the Amsler grid. The reference standard was ophthalmic examination. After removal of obviously irrelevant reports, 2 authors (J.B. and M.S.) independently screened the remaining references in full text for potential eligibility. Disagreements were resolved by a third author (Y.S.).Data Extraction and SynthesisTwo authors (J.B. and I.P.) independently extracted all data and evaluated quality and applicability of eligible studies using the Quality Assessment of Diagnostic Accuracy Studies 2. Disagreements were resolved by a third author (Y.S.).Main Outcomes and MeasuresSensitivity and specificity of the Amsler grid for detecting neovascular AMD with comparators being either healthy control participants or patients with nonneovascular AMD.ResultsOf 523 records screened, 10 studies were included with a total of 1890 eyes (mean participant age ranging from 62 to 83 years). Sensitivity and specificity to diagnose neovascular AMD were 67% (95% CI, 51%-79%) and 99% (95% CI, 85%-100%), respectively, when comparators were healthy control participants and 71% (95% CI, 60%-80%) and 63% (95% CI, 49%-51%), respectively, when control participants were patients with nonneovascular AMD. Overall, potential sources of bias were low across studies.Conclusions and RelevanceAlthough the Amsler grid is easy and inexpensive to use for detection of metamorphopsia, its sensitivity may be at levels typically not recommended for monitoring. Coupling this lower sensitivity with only moderate specificity to identify neovascular AMD in a population at risk, these findings suggest that such patients typically should be encouraged to undergo ophthalmic examination regularly, regardless of any results of Amsler grid self-assessment.

Evaluation of a Digital Amsler Grid (PocDoc) for Macular Disease Screening: A Comparative Analysis with the Conventional Method

“…Consistent with the findings of previous studies by Faes et al [ 19 ] and Bjerager et al [ 17 ], our study reaffirms the high specificity of the Amsler grid, in both its conventional and digital forms (PocDoc), for detection of age-related macular degeneration (AMD). Faes et al [ 19 ] reported a specificity of 0.97, while Bjerager et al [ 17 ] found it to be 99% compared with healthy controls. Our study aligns with these findings, demonstrating a specificity of 100% for both PocDoc and the conventional Amsler grid.…”

“…Similarly, an initial assessment of the Alley smartphone application in clinical practice demonstrated its efficacy in discriminating between different ocular conditions. These findings underscore the potential benefits of digital Amsler grid applications in early detection and continuous monitoring of AMD progression [ 17 ].…”

“…PocDoc, a digital Amsler grid, aligns with the emerging trend of utilizing digital platforms for AMD monitoring. Several digital Amsler grid applications are currently available commercially, such as the Foresee Home monitor [ 16 ], Alley (developed by Oculocare), and myVisionTrack (by Vital Art and Science) [ 17 ].…”

Prevalence of geographic atrophy in Nordic countries and number of patients potentially eligible for intravitreal complement inhibitor treatment: A systematic review with meta‐analyses and forecasting study

“…Clinically, a distinction is made between early AMD, which is defined by the presence of moderate‐sized drusen (63–125 μm) and no RPE changes, and intermediate AMD, which is defined by the presence of large drusen (>125 μm) or RPE changes (Fleckenstein et al, 2021). These early features of AMD only provide subtle if any visual symptoms (Bjerager et al, 2023; Fleckenstein et al, 2021). In contrast, progression of disease to late AMD often leads to significant visual symptoms (Bjerager et al, 2023; Fleckenstein et al, 2021).…”

“…These early features of AMD only provide subtle if any visual symptoms (Bjerager et al, 2023; Fleckenstein et al, 2021). In contrast, progression of disease to late AMD often leads to significant visual symptoms (Bjerager et al, 2023; Fleckenstein et al, 2021). In neovascular AMD, the development of macular neovascularization leads to exudative changes and subretinal fibrosis (Fleckenstein et al, 2021).…”